Acute cor pulmonale, a rare manifestation of carcinomatous lymphangiosis and hemangiosis

摘要

HISTORY AND CLINICAL DATA: A 33-year-old previously healthy woman developed acute cor pulmonale after nonspecific prodromal symptoms. Findings on echocardiography and computed tomography, elevated levels of d-dimers and progressively increased lactate dehydrogenase suggested recurrent small pulmonary emboli. DIAGNOSIS, TREATMENT AND COURSE: She was given i.v. heparin, but her condition abruptly deteriorated and, despite high-dosage fibrinolysis, she died in cardiopulmonary shock. Autopsy revealed chronic cor pulmonale and widely metastasized gastric carcinoma. Pulmonary embolism was excluded as the cause of death. CONCLUSION: Even currently available diagnostic means may fail to reveal advanced malignant disease, and the early diagnosis of gastric cancer remains a challenge. This case is also a reminder that autopsy may disprove a supposedly definite clinical diagnosis.